Provider Demographics
NPI:1932870961
Name:WOSKOBUNIK, TINA M
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:M
Last Name:WOSKOBUNIK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1810 E 42ND ST
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44055-2604
Mailing Address - Country:US
Mailing Address - Phone:440-444-5677
Mailing Address - Fax:
Practice Address - Street 1:1810 E 42ND ST
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44055-2604
Practice Address - Country:US
Practice Address - Phone:440-444-5677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-21
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0000296355OtherSUPPLIER ID